Abstract The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project designed to monitor maternal attitudes and behaviors before, during, and after pregnancy. In partnership between the Centers for Disease Control and Prevention and the Texas Department of State Health Services (DSHS), this project is a population- based assessment that monitors the health and behaviors of new mothers in the State of Texas. It provides up-to-date information regarding birth and pregnancy trends, covering topics such as prenatal care and substance use. PRAMS also serves as an excellent source for those seeking to learn more about and develop policy related to pregnancy and early infancy. The PRAMS sample of women who have had a recent live birth is drawn from the state's birth certificate file. Texas DSHS samples approximately 2,400 women per year. The data are stratified by race/ethnicity and birth weight to ensure adequate data are available in smaller but higher-risk populations. Selected women are first contacted by mail. If there is no response to repeated mailings, women are contacted and interviewed by telephone. The Texas PRAMS sample is collected and structured so that it is representative of all live births to women who are Texas residents. This means that the information pulled from the data can be generalized to represent the entire population of Texas. Thus, we are able to focus and explore the challenges and opportunities that are specific to improving the health and well-being of women and infants in the State of Texas.